纳布啡联合舒芬太尼对腹腔镜结直肠癌手术患者术后镇痛效果及应激反应的影响

Effects of Nalbuphine combined with Sufentanil on postoperative analgesia and stress response in patients undergoing laparoscopic colorectal cancer surgery

摘要:

目的 探讨纳布啡联合舒芬太尼对腹腔镜结直肠癌手术患者术后镇痛效果及应激反应的影响。方法 纳入2020年8月－2022年4月于该院行腹腔镜结直肠癌手术的患者86例，依照镇痛方案，分为实验组和对照组，各43例。对照组术毕给予舒芬太尼，实验组给予纳布啡+舒芬太尼。观察两组患者术后不同时点（术后1、6、12、24和48 h）的镇痛镇静效果、血清疼痛介质指标水平和应激反应指标水平变化情况。记录两组患者术后下床时间、自控镇痛次数、补救镇痛数、胃肠功能恢复情况和术毕48 h内不良反应发生情况。结果 与对照组比较，实验组术后首次下床时间较短（t = 3.29，P = 0.001），自控镇痛次数（Z = 4.53，P = 0.000）和补救镇痛数较少（χ² = 4.48，P = 0.034）；术后12、24和48 h，实验组视觉模拟评分法（VAS）明显低于对照组（t = 2.86，t = 2.55，t = 0.10，P < 0.05）；术后1和6 h，实验组患者Ramsay镇静评分低于对照组（t = 2.10，t = 2.07，P < 0.05）；术后6、12和24 h，实验组血清P物质（SP）（t = 3.63，t = 5.51，t = 3.46，P < 0.05）、前列腺素E2（PGE2）（t = 2.34，t = 3.56，t = 0.33，P < 0.05）水平均明显低于对照组；术后6、12和24 h，实验组血清皮质醇（Cor）（t = 4.65，t = 6.50，t = 6.52，P < 0.05）水平明显低于对照组；术毕6、12、24和48 h，实验组血清去甲肾上腺素（NE）（t = 5.49，t = 7.85，t = 7.70，t = 2.18，P < 0.05）、肿瘤坏死因子-α（TNF-α）（t = 5.43，t = 7.83，t = 5.27，t = 2.32，P < 0.05）和超敏C 反应蛋白（hs-CRP）（t = 3.39，t = 9.24，t = 4.87，t = 2.37，P < 0.05）水平均明显低于对照组。两组患者术后排气时间、排便时间、肠鸣音出现时间和不良反应发生率比较，差异均无统计学意义（P > 0.05）。结论 纳布啡联合舒芬太尼用于腹腔镜结直肠癌手术患者术后镇痛，效果显著，可有效调节机体手术创伤后应激反应。

Abstract:

Objective To investigate the impacts of Nalbuphine combined with Sufentanil on postoperative analgesia and stress response in patients undergoing laparoscopic colorectal cancer surgery.Methods 86 patients who underwent laparoscopic colorectal cancer surgery from August 2020 to April 2022 were collected and grouped into an experimental group and a control group according to the analgesic plan, with 43 patients in each group. The control group was given Sufentanil after surgery, and the experimental group was given Nalbuphine + Sufentanil. The analgesic and sedative effects at different time points after surgery (1, 6, 12, 24 and 48 h), and the changes in serum pain mediator and stress response indicators were observed and compared. The time of getting out of bed after surgery, the number of patient-controlled analgesia, the number of cases of remedial analgesia, the recovery of gastrointestinal function, and the occurrence of adverse reactions within 48 hours after surgery were recorded in both groups.Results Compared with the control group, the experimental group had a shorter time to get out of bed for the first time after surgery (t = 3.29, P = 0.001), and had fewer instances of patient-controlled analgesia (Z = 4.53, P = 0.000) and cases of remedial analgesia (χ² = 4.48, P = 0.034); Postoperative 12, 24 and 48 h after surgery, the visual analogue scale (VAS) in the experimental group was obviously lower than that in the control group (t = 2.86, t = 2.55, t = 0.10, P < 0.05); Postoperative 1 and 6 h, the Ramsay sedation score in the experimental group patients was lower than that in the control group (t = 2.10, t = 2.07, P < 0.05); Postoperative 6, 12 and 24 h, the serum substance P (SP) (t = 3.63, t = 5.51, t = 3.46, P < 0.05) and prostaglandin E2 (PGE2) (t = 2.34, t = 3.56, t = 0.33, P < 0.05) levels in the experimental group were obviously lower than those in the control group; Postoperative 6, 12 and 24 h, the serum cortisol (Cor) level in the experimental group was obviously lower than that in the control group (t = 4.65, t = 6.50, t = 6.52, P < 0.05); Postoperative 6, 12, 24 and 48 h, the serum norepinephrine (NE) (t = 5.49, t = 7.85, t = 7.70, t = 2.18, P < 0.05), tumor necrosis factor-α (TNF-α) (t = 5.43, t = 7.83, t = 5.27, t = 2.32, P < 0.05), and hypersensitivity C-reactive protein (hs-CRP) (t = 3.39, t = 9.241, t = 4.87, t = 2.37, P < 0.05) levels in the experimental group were obviously lower than those in the control group. There was no statistically obvious difference between the two groups in terms of postoperative exhaust time, defecation time, bowel sounds occurrence time, and incidence of adverse reactions (P > 0.05).Conclusion Nalbuphine combined with Sufentanil is effective in postoperative analgesia of laparoscopic colorectal cancer patients, and can effectively regulate the post-traumatic stress response of the body after surgery.